Is My Mammogram Covered By My Insurance

Is My Mammogram Covered By My Insurance?

Breast cancer screening services such as mammograms, can save lives. That’s why providing patients with information about the cost and accessibility of these scans is so important. Due to the Affordable Care Act (ACA), most health policies must cover certain elements of preventive care for women. That means no out-of-pocket costs as long as you stay within your provider network and qualify with your insurer. This is easy to ensure when you book your mammogram on Medmo.com

What Is A Mammogram? 

A mammogram is an X-ray picture of the breast. Doctors use a mammogram to look for early signs of breast cancer. Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt. Mammograms are the most trusted scan used to detect breast cancer at any stage. According to the CDC, if you find breast cancer at an early stage, you have a 98% chance of surviving. That’s the point of mammograms — they are screening tests that help find cancer when it is too small to feel. 

Will Insurance Cover A Mammogram?

However, insurance companies reserve the right to decide whether or not a procedure such as a mammogram is medically necessary. Most companies require that scans such as CT and MRI requests be subject to a “medical necessity review”. The purpose of this review is to determine whether a particular diagnostic test or treatment is appropriate and essential. Decisions are made based on the standard of care and the individual health plan’s policies and clinical guidelines. 

While states such as New York require insurance companies to be responsible for full payment of some breast imaging services such as screening and diagnostic mammograms (including 3D mammography), ultrasound, and MRI, that is not always the case. 

The fact is, mammography screening alone isn’t always enough to detect breast cancer. To find out, you may need another mammogram, ultrasound, breast MRI, or maybe even a biopsy. Those procedures are not guaranteed to be covered. This means there are a lot of wide ranges in how much follow-up scans cost and how much insurance will cover. According to a 2019 study conducted by The Martec Group for Susan G. Komen, the price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. Breast MRI costs an average $615 under Medicare and $1,073 with private insurance. When you consider that more than one test may be needed, it can add up to a big bill.The safest (but not always the easiest) way to see if your test will be covered, is to call your insurance company and ask.  

Another option is to compare pricing from individual imaging centers to find the best deal. This may be very time consuming, not to mention the other variables like location and  availability you also have to consider. That’s why Medmo offers set prices for scans at quality imaging centers. If your insurance doesn’t cover your test or if you don’t have coverage in general, getting the best out-of-pocket price for a mammogram or any other type of breast cancer screening isn’t always easy. There may be situations in which it’s more financially sound to pay cash, rather than deal with any insurance. Mammograms start at $200, breast MRIs start at $400, and breast ultrasounds start at $220. 

Medmo connects patients with medical imaging prices they can afford, guaranteeing patients will receive the most convenient and affordable services at quality centers, as well as lowering their out-of-pocket costs, even with insurance. 

To book a breast cancer screening, visit us at Medmo.com. Medmo helps people schedule radiology imaging tests – such as MRI, CT scans, PET, and more – at nearby accredited centers and identify the payment solution that works best for them.

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Is My Mammogram Covered By My Insurance?

The fact is, mammography screening alone isn’t always enough to detect breast cancer. To find out, you may need another mammogram, ultrasound, breast MRI, or maybe even a biopsy. Those procedures are not guaranteed to be covered. This means there are a lot of wide ranges in how much follow-up scans cost and how much insurance will cover.
Read more